Dame Kate Harcourt DCNZ

STORY BOOK  PHOTO ALBUM This resource has been prepared by the Health Quality & Safety Commission’s national programme, Reducing Harm from Falls, for use by health service providers in their falls prevention programmes.

It comprises:

 Key messages about falls prevention  Short and long form stories about Dame Kate’s fall  Images presented with falls prevention messages and suggested captions. No permissions are needed. Each image is available as a high resolution download from the webpage here.

For further information, please contact: Linley Boniface, Communications Advisor, Health Quality & Safety Commission Mobile: 027 948 1700 Email: [email protected]

DAME KATE HARCOURT STORY BOOK AND PHOTO ALBUM FOR APRIL FALLS 2014 page 2 [KEY MESSAGES]

Preventing falls in the community

Reducing the harm caused by falls like Dame Kate’s was the first focus area of the national patient safety campaign, Open for better care.

The campaign began with a focus on reducing the harm caused by falls in hospital, and has since moved on to concentrate on falls in age-related residential care and the community.

In the community, the emphasis should be on managing older people’s underlying medical conditions, maintaining their independence and keeping them safe at home – these are priorities on discharge from hospital and in primary care.

Measures that can help prevent falls among older people living in the community include:

 asking if they have had a fall in the past year as one of three simple falls risk screening questions (see the Ask, assess act project for a pocket card and further information)  offering multifactorial assessment and intervention for older people who answer positively to any one of the three screening questions  working on reducing falls risk in partnership with older people and their family/whānau  making homes safer by reducing potential trip hazards (eg. by using the home safety checklist ACC5128 How safe is your home?  encouraging older people at risk of vitamin D deficiency to seek advice from their GP or the health professional they see the most on whether they should be prescribed a vitamin D supplement.  supporting older people to stay active and exercise regularly  referring older people to exercise programmes to improve balance and increase lower body muscle strength - key contacts for matching patient/client needs with local programmes are Green Prescription coordinators and ACC community injury prevention consultants (enquire for contact details at [email protected]).

For more information, see /www.hqsc.govt.nz/our-programmes/reducing-harm

DAME KATE HARCOURT STORY BOOK AND PHOTO ALBUM FOR APRIL FALLS 2014 page 3 [SHORT STORY]

Dame Kate Shares Her Falls Story

Veteran actress Dame Kate Harcourt has had first-hand experience of the impact of a fall.

Dame Kate, 86, suffered a broken arm, nose and eye socket after tripping on a piece of wood outside in her front yard.

Dame Kate lives in Wellington with her daughter, actress Miranda Harcourt, son-in-law Stuart McKenzie and their three children: Thomasin, 13, Peter, 14, and Davida, 5. Miranda and Stuart were away when Dame Harcourt fell, but the three children joined forces to help.

Thomasin phoned an ambulance and contacted both sets of neighbours, Davida sponged the blood off Dame Kate’s face, and Peter went with his grandmother to hospital.

Falls can happen to anyone – neither Dame Kate nor her family expected her to fall.

Dame Kate’s fall exacerbated a back problem that made walking painful. Three months on from the accident, she was still having physiotherapy to recover movement in her hand.

The worst thing about the fall, says Dame Kate, was being unable to drive for six weeks, restricting her trips to the library and to see friends.

Dame Kate’s experience gave her a new awareness of the risk of falls, the importance of keeping homes free from hazards, and the need for older people to tell their GP if they’ve had a fall so that any contributing health problems can be investigated.

“I know I’m jolly lucky my fall wasn’t a lot worse, but it has still had a big affect on my life,” says Dame Kate. “I think it’s important for everyone to work together to do everything possible to prevent falls.”

DAME KATE HARCOURT STORY BOOK AND PHOTO ALBUM FOR APRIL FALLS 2014 page 4 [LONG STORY]

Dame Kate Shares Her Falls Story

Veteran actress Dame Kate Harcourt has had first-hand experience of the impact of a fall.

Dame Kate, 86, was leaving her Wellington home in the early evening to pick up her grandson when she tripped on a piece of wood in her front yard. She tumbled into the bonnet of her car and was knocked unconscious.

Her next memory is of waking up in hospital with a broken arm, nose and eye socket.

Dame Kate lives with her daughter, actress Miranda Harcourt, her son-in-law Stuart McKenzie, and their three children: Thomasin, 13, Peter, 14, and Davida, 5. Miranda and Stuart were away when Dame Harcourt fell, but Thomasin heard her grandmother moaning.

Fearing Dame Kate had been attacked, Thomasin went to the balcony of the house to see what had happened. When she saw Dame Kate was alone, she phoned an ambulance and contacted both sets of neighbours.

One neighbour went to pick up Peter while the other – a doctor – stayed with Dame Kate until the ambulance arrived.

Davida brought out a bowl of water and a sponge to clean away the blood on her grandmother’s face, and Peter arrived home in time to go to hospital with Dame Kate in the ambulance.

“My grandchildren were marvellous. I’m very proud of them,” says Dame Kate.

Falls are the leading cause of injuries to older people, and can happen to anyone. Neither Dame Kate nor her family expected her to fall, even though she’d broken her arm tripping over a garden hose a few years ago.

The worst thing about the fall, says Dame Kate, was being unable to drive for six weeks. Her family did her grocery shopping, but she wasn’t able to go to the library – she reads five books a week – or attend a regular Monday lunch with friends. She also had to cancel a voiceover job.

Three months after Dame Kate’s fall, the cast on her arm had been removed but it hurt to carry anything heavy. She was having physiotherapy to recover movement in her hand.

The fall also exacerbated an existing back problem, which made walking difficult. Walking is her main way of keeping fit, and Dame Kate knows fitness can help prevent falls.

Home safety is another way to reduce the likelihood of a fall. All the rugs in Dame Kate’s house have been removed, and she has a torch on her keyring to use whenever she goes outside in the dark.

Dame Kate is now more aware of the danger of falls, and of the need for older people to tell their GPs if they’ve had a fall so that any contributing health problems can be investigated.

“I know I’m jolly lucky my fall wasn’t a lot worse, but it has still had a big affect on my life,” says Dame Kate. “I think it’s important for everyone to work together to do everything possible to prevent falls.”

GENERAL PORTRAITS

DAME KATE HARCOURT STORY BOOK AND PHOTO ALBUM FOR APRIL FALLS 2014 page 5 ID Image Falls message Possible caption/s or text Use with HQSC342 Dame Kate Harcourt had a General falls fall at home, fracturing her prevention wrist. She has agreed to be communications the ‘face’ of the Health Quality & Safety Commission’s national falls programme.

“I know I’m jolly lucky my fall wasn’t a lot worse, but it has still had a big effect on my life,” says Dame Kate. “I think it’s important for everyone to work together to do everything possible to prevent falls.”

HQSC356 Dame Kate Harcourt has General falls agreed to be the ‘face’ of the prevention Commission’s national falls communications programme. She had a fall at home, fracturing her wrist.

Any fall, with or without injury, is a reason to implement an individualised plan of care that addresses an older person’s risk factors for falling.

In particular, a fracture in an older person should prompt assessment of bone health for risk of osteoporosis.

(See below for a note about fractures related to osteoporosis).

Brief note about osteoporosis and risk of fragility fracture Fractures in both women and men aged 50 years and over should be considered fragility fractures until osteoporosis is ruled out.1 Individuals who suffer a first fragility fracture are at double the risk of future 2 fractures compared with those who have never broken a bone, and at least half of those who break their hip have suffered a prior fragility fracture. 3,4

THEME: PREVENTING FALLS AND PROTECTING INDEPENDENCE

1 Eisman JA, Bogoch ER, Dell R et al. 2012. Making the first fracture the last fracture: ASBMR task force report on secondary fracture prevention. Journal of Bone and Mineral Research 27(10): 2039–46.

2 Kanis JA, Johnell O, De Laet C et al. 2004. A meta-analysis of previous fracture and subsequent fracture risk. Bone 35(2): 375–82.

3 Gallagher JC, Melton LJ, Riggs BL et al. 1980. Epidemiology of fractures of the proximal femur in Rochester, Minnesota. Clinical Orthopaedics and Related Research 150: 163–71.

4 Port L, Center J, Briffa NK et al. 2003. Osteoporotic fracture: missed opportunity for intervention. Osteoporosis International 14(9): 780–4.

DAME KATE HARCOURT STORY BOOK AND PHOTO ALBUM FOR APRIL FALLS 2014 page 6 ID Image Fa Possible caption/s lls m es sa ge HQSC289 Th Older people (or their families and caregivers) can go e online to learn about falls. Dame Kate has opened ACC’s ris booklet ‘Standing up to falls’ (ACC 2383 Standing up to k falls). Find the booklet and other resources at of www.acc.co.nz/older-people. fall ing do es inc re as e wit h ag e, but the go od ne ws is, yo u ca n do so me thi ng ab out it. HQSC082 Th ACC’s booklet ‘Standing up to falls: your guide to e preventing falls and protecting your independence’ is a ris good resource (ACC 2383 Standing up to falls). k of fall ing do es inc re as e wit h ag e, but the go

DAME KATE HARCOURT STORY BOOK AND PHOTO ALBUM FOR APRIL FALLS 2014 page 7 od ne ws is, yo u ca n do so me thi ng ab out it. HQSC093 Th Advice about falls prevention from health professionals e has credibility – family members and caregivers can also ris follow and reinforce these messages. k OR of ACC’s booklet ‘Standing up to falls: your guide to fall preventing falls and protecting your independence’ is a ing good resource (ACC 2383 Standing up to falls). do es inc re as e wit h ag e, but the go od ne ws is, yo u ca n do so me thi ng ab out it. HQSC108 Th Genuine concern helps establish rapport and trust for a e positive conversation about preventing falls and protecting ris an older person’s independence. k of fall ing do es inc re

DAME KATE HARCOURT STORY BOOK AND PHOTO ALBUM FOR APRIL FALLS 2014 page 8 as e wit h ag e, but the go od ne ws is, yo u ca n do so me thi ng ab out it. THEME: EXERCISE FOR BALANCE AND STRENGTH ID Image Fa Possible caption/s lls m es sa ge HQSC004 Ba Dame Kate looks at a balance and strength exercise lan leaflet with Gillian Watson, physiotherapist for older ce adults, Capital & Coast DHB. an d str en gth ex erc ise s ca n be do ne at ho me .

DAME KATE HARCOURT STORY BOOK AND PHOTO ALBUM FOR APRIL FALLS 2014 page 9 HQSC031 Ba Dame Kate is using the kitchen bench for support in these lan exercises. ce OR an Gillian Watson encourages Dame Kate to maintaining d good posture while exercising – “Think of a plumb line”. str en gth ex erc ise s ca n be do ne at ho me . HQSC037 Ba The single leg stand exercise is very effective for lan improving balance. ce an d str en gth ex erc ise s ca n be do ne at ho me . HQSC044 Ba Dame Kate on tip toes (the calf raise exercise), which lan helps balance and lower limb strength. ce an d str en gth ex erc ise s ca n be do ne at ho me .

DAME KATE HARCOURT STORY BOOK AND PHOTO ALBUM FOR APRIL FALLS 2014 page 10 HQSC304 Ba Gillian Watson says: “Lots of people find it hard to get out lan of a low chair. Lean forward and use your hands to push ce forward.” an d (However, if an older person cannot get out of a dining str chair without using their hands, then they have a high fall en risk because of poor lower limb strength. Using a dining gth chair for the ‘sit-to-stand’ exercise is good for balance and ex lower limb strength.) erc ise s ca n be do ne at ho me . HQSC426 Ke Enjoying the sunshine outdoors also helps vitamin D epi levels. ng  From September to April, take a walk or do outside act activities in the early morning or late afternoon. ive Remember to be SunSmart through the middle of the an day. d  From May to August, take a walk or do outside enj activities in the middle of the day, with your face, arms oyi and hands uncovered. ng the out do ors is im po rta nt. HQSC433 Ke Keeping active and enjoying the outdoors is important. epi OR ng Gillian Watson says, “Pick an activity you enjoy for your act exercise routine, such as walking outdoors”. ive an d enj oyi ng the out do ors is im po rta nt.

DAME KATE HARCOURT STORY BOOK AND PHOTO ALBUM FOR APRIL FALLS 2014 page 11 HQSC436 Ke Gillian Watson says: “Walking on a slightly uneven epi surface such grass is a good challenge for your balance – ng use it or lose it!” act ive an d enj oyi ng the out do ors is im po rta nt.

DAME KATE HARCOURT STORY BOOK AND PHOTO ALBUM FOR APRIL FALLS 2014 page 12 THEME: ENSURE APPROPRIATE FOOTWEAR ID Image Falls message Possible caption/s Use with HQSC168

Ensure older people wear well-fitting, flat shoes with non-slip soles for increased stability. Gillian Watson says: “This shoe ticks all the boxes: it’s fitted around the heel with straps over the top and it has a medium weight flexible sole.” Ask, assess, act project

Topic 2 Topic 3 Topic 4 HQSC177

Ensure older people wear well-fitting, flat shoes with non-slip soles for increased stability. Dame Kate likes the velcro straps on this shoe – it makes it easy to get them on and off, and easy to adjust if your feet swell. Ask, assess, act project

Ensure older people wear well-fitting, flat shoes with non-slip soles for increased stability. Gillian Watson says: “Slippers like this aren’t so good. Avoid loose-fitting, slip-on styles. They change how you walk - you’re ‘scuffing to keep them on, and it’s easy to trip”. Ask, assess, act project Topic 2 Topic 3 Topic 4 HQSC197

Ensure older people wear well-fitting, flat shoes with non-slip soles for increased stability. Gillian Watson says: “A low heel is best, but a modest heel like this could be worn on special occasions.” Ask, assess, act project

Ensure older people wear well-fitting, flat shoes with non-slip soles for increased stability. Safety and style - you can have a good range of nice, lightweight shoes that support your feet and help you walk safely. Ask, assess, act project

Topic 2 Topic 3 Topic 4 THEME: OPTIMISE VISION ID Image Falls message Possible Use with caption/s HQSC115 Optimise older Many falls are Ask, assess, act people’s vision to caused by project reduce their risk wearing bi-focals of falling. or reading Topic 2 glasses outdoors. Topic 3 Advise older Topic 4 people to use their reading glasses only for reading, and to ask their optician for single lens glasses to wear when active outside. HQSC132 Optimise older Ask older people: Ask, assess, act people’s vision to “When did you project reduce their risk last have your of falling. eyes tested?”. Topic 2 OR Topic 3 Advise older Topic 4 people: “Wear your reading glasses only for reading. Ask your optician for single lens glasses for when you are out and about”.

HQSC137 Optimise older “Keep your Ask, assess, act people’s vision to glasses clean.” project reduce their risk of falling. Topic 2 Topic 3 Topic 4

HQSC150 Optimise older Advise older Ask, assess, act people’s vision to people to take project reduce their risk extra care until of falling. they are used to Topic 2 their new glasses. Topic 3 Topic 4

THEME: PRESCRIBED VITAMIN D Possible ID Image Falls message Use with caption/s HQSC049 Prescribed Dame Kate with Prescribed vitamin D is ACC’s card: vitamin D widely ‘Vitamin D: is it initiatives recommended right for you? Ask around the world your GP’. Topic 7 for preventing OR falls in older Vitamin D: is it people at higher right for you? Ask risk of falling. your GP. OR HQSC058 Ask your GP about vitamin D.

HQSC406 Your doctor may From September Prescribed suggest that you to April, take a vitamin D spend more time walk or do initiatives in the sun to outside activities increase your in the early Topic 7 vitamin D. morning or late afternoon. Remember to be SunSmart through the middle of the day. HQSC410 From May to August, take a walk or do outside activities in the middle of the day, with your face, arms and hands uncovered.

HQSC412

THEME: HOME SAFETY ID Image Falls message Possible Use with caption/s HQSC067 The risk of falling Dame Kate works Topic 4 does increase through the ACC with age, but the home safety good news is, checklist you can do something about (ACC5128 How it. safe is your home?) HQSC080 OR Complete the ACC home safety checklist – as it says, “You may know your home like the back of your hand, but the things you see every day could be potential hazards that can lead to a fall”. (ACC5128 How safe is your home? )

HQSC227 The risk of falling Do your rugs lie Topic 4 does increase flat, without frayed with age, but the corners or rolled good news is, up edges? you can do something about it.

HQSC255 The risk of falling Dame Kate takes Topic 4 does increase up a rug that with age, but the could cause a trip good news is, or fall. you can do something about OR it. Remove rugs that could cause a trip or fall.